254 
DISEASE OF THE LACHRYMAL PASSAGES. 
in insinuating into the duct, through which it readily passed on- 
ward to the extent of seven inches ; then, on further force being 
used, it bent, as the first had done, and was in consequence 
withdrawn. The act of withdrawal I found to require more 
force than the introduction, in consequence of the cohesion be- 
tween the membrane and bougie, arising from the latter having 
become softened ; and the result was that, just as the operation 
was concluded, about one-eighth of an inch of the end of the 
bougie broke off and remained within the puncture : however, it 
easily became extracted with a pair of dissecting forceps. Still, 
such an accident, which might have proved serious, was enough 
to make me resolve in my mind not again to use the common 
bougie, but to have a whalebone probe manufactured for the 
purpose. For this time, therefore, I released my patient. 
5th . — The eye shews a slight inflammatory appearance from 
what was done yesterday; but the flow of tears over the face 
is diminished, leading me to believe that the bougie has done 
some good. At the exit of the duct within the nostril there is 
a little coagulum resting. 
6th . — Tears still running over the cheek, and, having provided 
myself with a whalebone probe of sufficient length — thirteen 
inches — and the requisite size, I determined, this morning, to 
renew my attempts to permeate the duct. I also had, this time, 
by me, a pewter syringe, with a nozzle sufficiently pointed and 
fine to enter the puncta. I first introduced the whalebone probe, 
as on a former occasion I had the bougie, which passed readily 
enough into the lachrymal sac, but required withdrawing for a 
little way, and variously manipulating before I could get it to 
enter the duct. Presently it did so, and then with slight force 
was easily pushed onward to the extent of eight inches : here it 
stopped, and no pressure safe to be used could force it further. 
It had, in fact, reached the tortuous part of the canal, through 
the curvatures of which I was not able to make it pass : I there- 
fore withdrew it. 1 next tried what effect syringing the puncta 
would have: the warm water was readily injected into the sac, 
which instantly became distended ; but, instead of flowing on- 
ward into the duct, all of it regurgitated into the eye. Now I 
thought I would apply the syringe to the aperture of the duct 
within the nose ; first, however, passing up the probe. The 
probe could not be pushed up further than about two inches ; 
stopping, as it had done before, at the part where the canal 
grows tortuous. The injected water, however, found passage and 
exit through the puncta, flowing out in a continuous stream over 
the eye. I served the opposite eye in the same manner, succeed- 
ing equally well, and then suffered my patient once more to 
